Faculty Bibliography

NEEDS AND OBJECTIVES: To address rising education costs, physician shortages, and the need for educational reform, several medical schools have developed accelerated 3-year MD programs. In 2013, NYU School of Medicine began its new 3-year MD program with guaranteed acceptance into residency upon graduation. Using the AAMC's 13 Core Entrustable Professional Activities for Entry into Residency (CEPAER) framework, we designed an immersive 4-hour simulated "Night on Call" (NOC) experience to compare performance of our first graduating cohort of fifteen 3-year MD students (3A), with third (3T) and fourth year (4T) students in the traditional 4-year MD program. SETTING AND PARTICIPANTS: 73 medical students (39 women, age 26.5 (+2.6) years; 36 '3T', 12 '3A', 25 '4T') completed an IRB-approvedNOC at our simulation center 4 weeks prior to the end of their third or final year of medical school. DESCRIPTION: We developed NOC to measure competence and entrustment across all 13 CEPAERs from the perspective of patients, nurses, and attendings. During the simulation, a medical student rotated through a series of 8 clinical coverage scenarios including: 4 standardized patient (SP) cases with varying degrees of complexity, each of which require answering a call from a standardized nurse (SN), evaluating an SP with the SN in the room, making immediate management decisions and writing a coverage note; a phone call to an experienced clinician to orally present (OP) the case; formulation of a clinical question and finding the most appropriate evidence-based medicine (EBM) answer using digital library resources; a clinical vignette (CV) to test ability to recognize a pre-entrustable peer; and a handoff (HO) of 4 cases to a peer (a senior medical student). CEPAERs assessments based on validated tools included communication, physical exam, patient education and interprofessional teamwork skills assessed by an SP and SN, and clinical reasoning based on notes, OP, EBM, CV, HO. Each rater also provided an entrustment judgment. EVALUATION: Although overall student performance improved across cases and some interesting individual performance patterns emerged, there were no significant differences across the three groups in the core competency and entrustment measures evaluated across various NOC activities. DISCUSSION/REFLECTION/LESSONS LEARNED: The 13 CEPAERs are meant to define what students should be expected to perform (without direct supervision) prior to entering residency. Our results, based on multiple rater perspectives, suggest that our cohort of 3A students is as prepared for residency as their 4T counterparts

AIM: To assess the feasibility and utility of measuring baseline professional identity formation (PIF) in a theory-based professionalism curriculum for early medical students. METHODS: All 132 entering students completed the professional identity essay (PIE) and the defining issues test (DIT2). Students received score reports with individualized narrative feedback and wrote a structured reflection after a large-group session in which the PIF construct was reviewed. Analysis of PIEs resulted in assignment of a full or transitional PIF stage (1-5). The DIT2 score reflects the proportion of the time students used universal ethical principles to justify a response to 6 moral dilemma cases. Students' reflections were content analyzed. RESULTS: PIF scores were distributed across stage 2/3, stage 3, stage 3/4, and stage 4. No student scores were in stages 1, 2, 4/5, or 5. The mean DIT2 score was 53% (range 9.7?76.5%); the correlation between PIF stage and DIT score was rho = 0.18 (p = 0.03). Students who took an analytic approach to the data and demonstrated both awareness that they are novices and anticipation of continued PIF tended to respond more positively to the feedback. CONCLUSIONS: These PIF scores distributed similarly to novice students in other professions. Developmental-theory based PIF and moral reasoning measures are related. Students reflected on these measures in meaningful ways suggesting utility of measuring PIF scores in medical education.

Program/Project Purpose: The New York University School of Medicine (NYUSOM) has been engaging medical students in global health across their years in medical school through its' International Health Program (IHP) since 2002. All students in good academic standing are supported to participate in culturally meaningful and socially relevant research in any location that meets US State Department safe travel advisories. Students can also participate in self-funded clinical rotations. The program aims to increase the cultural competency of medical graduates as they enter the workforce to serve an increasingly diverse patient population. Our assumption was that IHP participants would have increased cultural competency, increased engagement with underserved populations, and increased incorporation of global health in their career paths. Structure/Method/Design: To understand the impact of this program we conducted a simple cross-sectional cohort study of graduates of the program from 2002 to 2012. Survey questions included demographic data as well as subjective impact of the IHP program on their residency and career choices. Outcome & Evaluation: We received 49 responses out of 213 surveys distributed by email to past participants of the IHP. Analysis of the data showed that international experiences later in medical school, rather than earlier, had a higher impact on career plans (mean of 2.70 verses mean of 2.00). Moreover, electives with both research and clinical components positively impacted career plans. Clinical rotations appeared to have slightly more impact on cultural competency than research rotations (mean of 3.82 verses mean of 3.39). Students who had not studied abroad previously (n = 24) reported that IHP had a greater impact on cultural competence, commitment to global health, and commitment to caring for the under-served than those who had previously studied abroad (n = 24). Going Forward: International heath experiences for medical students appear to have a significant impact on career paths as well as improving cultural competency. These findings can potentially benefit human resources for health by increasing US graduates long-term engagement in global public health and for working with underserved populations. We feel there is also strong argument for supporting first time international experiences for medical students